Unsettling: What psychosis looks like in children and young people

This eerie painting is by a young woman of 22 diagnosed with schizophrenia. She is encountering a threat, real or imagined, and her paranoia is compounded by being watched from the window above. Note the symbolic references to communications links and satellites.

Odd, eccentric, a little weird: people experiencing psychosis are living in dream space. If you haven’t experienced psychosis yourself, it’s a little like the period just before you awake, when you’re in a dream but also aware of your surroundings. Your dream and emerging consciousness weave together in a wonderful or horrible or simply odd narrative. If you try to explain it someone, you realize it makes no sense, yet it made a lot of sense while you were dreaming.

To a parent watching a psychotic child, you may observe that they see, feel, hear, move about, and respond to you as if fully conscious, but it’s important to know that they simultaneously inhabit the subconscious. As a result, they don’t notice that what they do and think is any different from anyone else. The term “anosognosia” refers to their inability to recognize this, and it explains why so many resent being told they have a problem and need treatment. They simply aren’t aware that anything is different about them.

Evidence of psychotic behavior

Parents of a child who was eventually diagnosed with a psychotic disorder often report that their child was always a bit different from their peers–slightly eccentric, a unique individual who had an interesting way of looking at the world. Parents have also reported the following behaviors when their child was exhibiting psychosis. (Not all of these are present in each child.)

A belief in something that isn’t rational, and the belief is unusual or unreal or impossible. The person cannot be talked out of the belief. And rational, logical reason only increases resistance to reason.

If the psychotic episode is positive or magical, the person may have powerful religious feelings and a sense of omnipotence or clairvoyance. They may believe they have been instructed to give a message to save the world, for example.

If the episode is negative and paranoid, they can become very agitated, fearful, or they may panic. They may act negatively on irrational beliefs. They are attracted to paranoid or extremist views, especially those with high emotional content.

Smiling or laughing at nothing in particular and for no apparent reason. It’s as if someone has just told them a joke.

Yelling or ranting, this could be at an object or at someone or at nothing apparent. The ranting can happen online. The ranting has repeated themes, and the themes are unique to each person.

Talking and gesturing as if they’re in a conversation with an invisible someone. (Normal people also gesture they think, but they are aware they are not literally communicating with someone.)

Wandering eyes and shifting body language as if they are seeing or feeling things that aren’t there.

Abrupt personality change from seemingly normal behavior. Often, a child’s eyes will have a disquieting faraway ‘look’, as if the child is not in their body, and a they’ve been overtaken by a demon.

Fear, anxiety, and paranoia–they feel watched, trapped, and controlled in some way. They stop trusting people. They hide or try to block experiences to protect themselves.

Intense obsessions with ideas, things, or events (even if they occurred long past). Themes emerge which often refer to actual events that elicited strong emotions.

Seeing patterns and connections in events that aren’t connected.

Unusual and confusing responses when communicating with others—a comment that doesn’t seem to apply, or a a string of words that defy interpretation.

A preference for solitude and closing themselves off from others. This is for self-protection.

Loss of interest in self-care: not wearing clean clothes, bathing, or organizing their surroundings.

The most common diagnoses that have psychotic features are schizophrenia, schizoaffective disorder, bipolar disorder, and depression. This story about schizoaffective disorder gives some real world examples of psychosis: “Life with a Schizoaffective Teen.”

Psychotic behavior can have a long slow onset

The image on the left is of a 15-year-old boy with early onset schizophrenia. The purple regions have normal neuron density, red regions have low neuron density. In the 2nd image, the red area at the top of the brain is in the cerebral cortex, the region of executive function and rational thought.

It’s easy to miss signs of early psychosis! Sometimes a child or young person starts showing eccentric behaviors that aren’t serious or are easy to interpret as something else: creativity and imagination; immaturity; puberty; influences from immature friends; too much video gaming… Your child may have been experiencing mild visual or aural hallucinations for some time, even a couple of years, and just assumed it happened to everyone so they never reported it. As psychosis emerges in the early teens, their thoughts and behaviors start affecting friendships or school work. The child stops doing things they once enjoyed. Someone might assume they’re experimenting with drugs. They seem so much like other difficult, distracted, or defiant teens that a parent can be lulled into thinking they are not seriously mentally ill… but psychosis is very serious.

If this describes your child, immediately (and I mean immediately) find a psychiatrist and get an assessment. The earlier you can treat psychosis, the better the outcome for your child. Psychosis is degenerative. The longer a brain stays in a state of psychosis, the more neurons it loses. Early treatment via therapies, medication, diet, and other physical supports can literally prevent neuron loss and future psychotic breaks that require hospitalization.

Psychosis can emerge abruptly

For disorders on the schizophrenic spectrum, this is common in young men in the late teens and early 20’s. However, adults in their 30’s and 40’s have also been known to have sudden onset of psychosis. It’s tragic, you witness this young person launching into adulthood, studying in college or starting employment, and suddenly his or her personality changes. Their behavior worsens, and it becomes evident they’ll never be able to have the future they planned. They need immediate treatment, possibly hospitalization if the psychotic break reaches a crisis point. If this is your child and they are past age 18, use every means possible to get help for them!

Self-portrait by a 24-year-old woman diagnosed with schizoaffective disorder. Her image is a modified mug shot photo taken of her after an arrest.

What worsens psychosis and what you can do to relieve it

Poor sleep and reduced sleep.

Help your child get enough hours of sound sleep. The best sleep environment is a cool very dark room. Once my child became unable to attend high school, I allowed her to nap any time of the day.

Closing themselves off from the world.

Your child needs mental and sensory stimulation to keep their mind from spinning out on their obsessions, hallucinations, and paranoia, but the amount must be tolerable. Stimulus must come from the tangible, sensory world (e.g. not screen time, videos, books). Concrete interaction with reality diverts their attention from obsessive thoughts or voices. They will benefit from regular (perhaps limited) social interaction*, an undemanding therapy animal, creative work (such as art and music), and being out in nature.

Marijuana use–specifically the THC in marijuana

CBD in marijuana has many medical benefits and is considered safe, but the THC is not. THC is also addictive, and available in very highly concentrated oils… extremely dangerous. Like THC, any addictive substance, from alcohol to methamphetamine, will interfere with treatment for psychosis. The drug’s influence trumps everything. Drugs are literally self-induced psychosis. See: “Marijuana is Uniquely Harmful to Troubled Teens”; “Marijuana is Dangerous.”

Continual exposureto things they already obsess on or that make them paranoid, angry, or anxious.

In every way possible, keep your child away from any material, people, or messages that upsets them. These only add gasoline to the fire and increase the likelihood of future psychotic breaks. They may obsess on the same things for the rest of their lives. If someone who’s psychotic is exposed to intense emotional experiences that feed their obsessions and paranoia, people have been known to do to horrible things to themselves or others. An example at the time of this writing is of a young woman with psychotic bipolar mania who tragically pulled out her own eyes.

Find ways to redirect your child’s attention elsewhere and help them get a grasp on the reality. Help them calm down (“deescalate” them) and help them learn ways to calm themselves down.

A diagnosis of an illness that includes psychosis is devastating

Psychosis and/or a psychotic crisis in a child who previously led a normal healthy life blindsides everyone, especially the family. Allow yourself to go through the stages of grief as you would after any death… because it can feel like the ‘death’ of your child and their future and your hopes for them. Get help from others as you would after any death. Here you are, grieving, but your child needs you to be strong! Get help for your own mental health.

Reason for hope

Children who receive regular social support from family and loved ones do well over the decades. They can avoid homelessness, hospitalizations, harm. They can get advanced education, keep strong relationships, maintain employment. They get a life of wellbeing. This has happened with my adult child after years of horrendous experiences.

A relatively new therapy has been developed and tested that meaningfully helps people with chronic psychotic disorders. “CET attempts to increase mental stamina, active information processing, and the spontaneous negotiation of unrehearsed social challenges. It does so with a focus on enhancing perspective taking, social context appraisal, and other components of social cognition… CET has been shown to have remarkable and enduring effects in a study of persons with schizophrenia or schizoaffective disorder…”–CET Training LLC, “approved and recognized by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) as an evidence-based practice.

Theoretical models have suggested that social relationships influence health through stress reduction and by more direct protective effects that promote healthy behavior. A recent study confirms this concept. Findings from a meta-analysis published in PLoS Medicine indicate that social interaction is a key to living longer. Julianne Holt-Lunstadt, PhD of Brigham Young University and colleagues analyzed data from 148 published studies (1979 through 2006) that comprised more than 300,000 individuals who had been followed for an average of 7.5 years. Not all the interactions in the reports were positive, yet the researchers found that thebenefits of social contact are comparable to quitting smoking, and exceed those of losing weight or increasing physical activity.

Results of studies that showed increased rates of mortality in infants in custodial care who lacked human contact were the impetus for changes in social and medical practice and policy. Once the changes were in place, there was a significant decrease in mortality rates. Holt-Lundstadt and colleagues conclude that similar benefits would be seen in the health outcomes of adults: “Social relationship-based interventions represent a major opportunity to enhance not only the quality of life but also of survival.”

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2 Replies to “Unsettling: What psychosis looks like in children and young people”

This is the best article I have ever read. Thank you so so very much. This explains exactly what our family has gone through for the past 10 years with our now adult daughter. I feel validated and that makes me feel hopeful.

Thank you so much for your comment. I hope you will be able to help your daughter, and that she will be able to accept help. A book I recommend that helped me was “I’m Not Sick, I Don’t Need Help! – How to Help Someone with Mental Illness Accept Treatment.” The author is Xavier Amador, a psychiatrist who learned from his schizophrenic brother what worked best to get him to get treatment and stay in treatment.

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